实时剪切波弹性成像与彩色多普勒超声在宫颈癌鉴别诊断中的应用价值

Application of real-time shear wave elasticity imaging and color Doppler ultrasonography in the differential diagnosis of cervical cancer

目的探讨实时剪切波弹性成像与彩色多普勒超声在宫颈癌鉴别诊断中的应用价值。方法选取2015年1月至2016年6月间新疆医科大学附属肿瘤医院收治的114例宫颈病变患者,分别采用实时剪切波弹性成像与彩色多普勒超声进行检测诊断,以病理诊断结果为金标准,比较两种检验方案的敏感性、特异性及准确性。结果病理结果显示,114例患者包括宫颈癌42例及宫颈上皮内瘤变(CIN)72例。宫颈癌中鳞状细胞癌35例,腺癌7例,均为单发病灶,宫颈上皮内瘤变中,CIN I 29例,CINⅡ27例,CINⅢ16例。宫颈癌患者平均弹性模量为(74.9±16.3)k Pa,与CIN患者的(24.1±2.9)k Pa比较,差异有统计学意义(P<0.05)。实时剪切波弹性成像诊断敏感性、特异性及准确性分别为88.1%、88.9%和88.6%,彩色多普勒超声诊断敏感性、特异性及准确性分别为61.9%、81.9%和75.6%,两组比较,差异均有统计学意义(均P<0.05)。一致性检验结果显示,三名超声科医师的实时剪切波弹性成像的Kappa值为0.845,一致性较好,彩色多普勒超声的Kappa值为0.568,一致性一般。结论实时剪切波弹性成像在宫颈癌鉴别诊断中的应用价值要高于彩色多普勒超声,具有较好的一致性,且诊断准确率较高,值得在临床上推广和应用。

Objective To compare the value of real-time shear wave elasticity imaging and color Doppler ultrasonography in the differential diagnosis of cervical cancer. Methods A total of 114 patients with cervical lesions were enrolled at Xinjiang Medical University Affiliated Tumor Hospital from January2015 to June 2016. Real-time shear wave elastic imaging and color Doppler ultrasonography were used,respectively. The pathological results were considered as gold standard. The sensitivity,specificity and accuracy of the two detection protocols were compared. Results Pathological results showed that among the 114 patients,42 with cervical cancer and 72 with cervical intraepithelial neoplasia（ CIN）. Among patients with cervical cancer,7 with adenocarcinoma and all were single lesions. Among patients with CIN,29 with CIN I,27 with CIN II and 16 with CIN III. The average elastic modulus was（ 74. 9 ± 16. 3） k Pa for patients with cervical cancer and（ 24. 1 ± 2. 9） k Pa for patients with CIN（ P〈0. 05）. The sensitivity,specificity and accuracy was 88. 1%,88. 9% and 88. 6% for shear wave elasticity imaging and 61. 9%,81. 9% and75. 6% for color Doppler ultrasonography（ all P〈0. 05）. Consistency test showed that the Kappa value of real-time shear wave elastic imaging was 0. 845 for three ultrasound physicians and the consistency was good. The Kappa value of color Doppler ultrasound was 0. 568 and the consistency was general. Conclusion The significance of real-time shear wave elastic imaging in the differential diagnosis of cervical cancer is higher than that of color Doppler ultrasonography and it is well consistent and has high diagnostic accuracy and is worthy to be popularized and applied clinically.